Provider Demographics
NPI:1588267884
Name:BANKASHE, HAILU MOLLA
Entity type:Individual
Prefix:
First Name:HAILU
Middle Name:MOLLA
Last Name:BANKASHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15130 STONE LN N APT D201
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-2923
Mailing Address - Country:US
Mailing Address - Phone:206-637-9301
Mailing Address - Fax:
Practice Address - Street 1:15130 STONE LN N APT D201
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-2923
Practice Address - Country:US
Practice Address - Phone:206-637-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4471171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4471OtherDSHS